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HomeMy WebLinkAboutT15N R1W SEC 7 LT 95MUNICIPALITy OF ANCHORAG4 �^DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTIOtq HEALTH AUTHORITY APPROVAL (HAA) (,1 3 7g8J CHECKLIST - FEBRUARY 1984 264-4720 () Legal Description:!\��® E `1 .Se C i �J A. WELL DATA Well Classification ��'/UA TC If A, B, C, D.E.C. Approved (Y/N) A�_ Well Log Present (Y/N) Date Completed f'+-�- /P 2S' Yield Total Depth HAg�4x 2�/ Cased to e!O t Depth of Grouting X14 Static Water Level -37 / Pump Set At %d rr Casing Height Above Ground g Sanitary Seal on Casing (Y/N) LVI Electrical Wiring in Conduit (Y/N) / Depression Around Wellhead (Y/N) Al/ Separation Distances from Well: To Septic/Holding Tank on Loth ; On Adjoining Lots r � To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots — To Nearest Public Sewer Line`s To Nearest Public Sewer Cleanout/Manhole �`'�"� To Nearest Sewer Service Line on Lot `-'- Water Sample Collected by _'Cos 4_1 e/ qhs' r, ; Date�r/��y Water Sample Test Results `S-, /-r r PC-, >1i`'" %off r Comments B. SEPTIC/HOLDING TANK DATA Date Installed l��o' Size _ /U'2 e'? No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) 1 Depression over Tank (Y/N) Date Last Pumped 3� 7` le `fj— Pumping/Maintenance Contract on File (Y/N) AJ %'A —;for Holding Tank High -Water Alarm (Y/N) I'Lll Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well Y.CiL To Building Foundation �� r i To Property Line To Disposal Field 52'y To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) /o p' To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata s��� Type of System Design % Ye c Date Installed JCC/ k1 Length of Fieldr/ Width of Field �/'11/'11� Depth of Field �— f Gravel Bed Thickness / Square Feet of Absorption Area / 3 2 Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Testeoy'/ Results of Last Adequacy Test Separation Distance from Absorption Field: i y= To Water -Supply Well % /_171 To Property Line /d To Building Foundations To Existing or Abandoned System on Lot On Adjoining Lots To Water Main/Service Line % U To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) "Pump Off" Level at — Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �� ti Date Company ,' MOA No. S7_ 6 E Receipt No. zw = a Date of Payment Amount: $ ����a- n °^ AA° (� Engineer's Seal J T �'.r o eo °°a r e oococ c 000°DD�„ D ;r� �' A���rrrc1110 te00000°O i� E 1 o Louis A. Bufera Page 2 of 2 �� `��o° CE -6736 O °pO DC FOODO° L7 72-026 (11/84) © %%\ QV miunicipality o Anchorage October 11, 1985 P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Lou Butera, P.E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request WR85-040, T15N R1W Section 7 Lot 95 Dear Mr. Butera; Your request for a waiver of the required 100 foot separation distance for a private well to a septic tank on the subject lot has been denied. If the septic tank can be shown to be equipped with watertight, caulder type couplings this waiver request will be reconsidered. If you have questions regarding this matter, I can be reached at 264-4720. Sincerely, 4. Stephen S. Morris Civil Engineer On-site Services